Archives de catégorie : Passerelle / Gateway

Les études qui montrent ou réfutent que la vape sert de passerelle vers le tabac.
The studies that try to show or deny that vaping is a gateway to smoked tobacco

Gateway effects: why the cited evidence does not support their existence for low-risk tobacco products (and what evidence would)

It is often claimed that low-risk drugs still create harm because of “gateway effects”, in which they cause the use of a high-risk alternative. Such claims are popular among opponents of tobacco harm reduction, claiming that low-risk tobacco products (e.g.,ecigarettes, smokeless tobacco) cause people to start smoking, sometimes backed by empirical studies that ostensibly support the claim. However, these studies consistently ignore the obvious alternative causal pathways, particularly that observed associations may represent causation in the opposite direction (smoking causes  people to seek low risk alternatives) or confounding (the same individual factors increase the chance of using any tobacco product).

Published: 9 March 2015

Positive: Yes

Link to publication: http://antithrlies.com/2015/03/12/new-phillips-working-paper-on-thr-related-gateway-claims/

Author:

Carl V. Philips (CASAA)


Summary

Abstract

It is often claimed that low-risk drugs still create harm because of “gateway effects”, in which they cause the use of a high-risk alternative. Such claims are popular among opponents of tobacco harm reduction, claiming that low-risk tobacco products (e.g., ecigarettes, smokeless tobacco) cause people to start smoking, sometimes backed by empirical studies that ostensibly support the claim. However, these studies consistently ignore the obvious alternative causal pathways, particularly that observed associations may represent causation in the opposite direction (smoking causes people to seek low risk alternatives) or confounding (the same individual factors increase the chance of using any tobacco product). Due to these complications, any useful analysis must to deal with simultaneity and confounding by common case. In practice, existing analyses provide almost cartoon examples of drawing naïve causal conclusions from observed associations. The present analysis examines what evidence and research strategies would be needed to empirically detect such a gateway effect, if there were one, explaining key methodological concepts including causation and confounding, examining the logic of the claim, identifying potentially useful data, and debunking common fallacies on both side of the argument, as well as presenting an extended example of proper empirical testing. The analysis demonstrates that none of the empirical studies to date that purport to show a gateway effect from tobacco harm reduction products actually does so. The observations and approaches can be generalized to other cases where observed association of individual characteristics in cross-sectional data can result from one or several causal relationships.


Conclusion

Searching for some signal of a gateway effect amidst overwhelming confounding requires more rigorous methods than are typical in public health epidemiology. This generalizes to any attempt to use cross-sectional data to sort out causation in a particular direction from confounding or reverse causation. When seeking epidemiologic associations where confounding is minimal or relatively simple in its causes, the typical methods used in the field are still far from optimal, but the empirical results might still be basically useful. That is not the case in this context. While it might never be possible to convincingly demonstrate a gateway effect given the challenges, and statistical analyses have no hope of detecting a tiny effect, there are clearly better and worse ways to pursue the question.

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The impact of flavor descriptors on nonsmoking teens’ and adult smokers’ interest in electronic cigarettes

Smokers switching completely from combustible cigarettes to  e-cigarettes are likely to reduce health risk, suggesting that e-cigarettes should be made appealing to adult smokers. However, uptake of e-cigarettes by nonsmoking teens would add risk without benefit and should be avoided. Although e-cigarette flavors may appeal to adult smokers, the concern is that flavors might attract nonsmoking teens.

Published: 7 January 2015

Positive: Yes

Link to publication: http://ntr.oxfordjournals.org/content/early/2015/01/06/ntr.ntu333.short?rss=1

Reply from Glantz: http://tobacco.ucsf.edu/shiffman-et-al-paper-nicotine-tobacco-research-not-reliable-estimate-effects-ecig-flavors

Authors

Saul Shiffman, PhD
Mark A. Sembower, MS
Janine L. Pillitteri, PhD
Karen K. Gerlach, PhD,, MPH
Joe G. Gitchell, BA


 

Summary

Methods:

Nonsmoking teens (n=216, ages 13-17, no tobacco in past 6 months) and adult smokers (n=432, ages 19-80, smoking 3+ years; could have used e-cigarettes) were recruited from an Internet research panel. In assessments completed online (May 22 to June 13, 2014), participants indicated their interest (0-10 scale) in e-cigarettes paired with various flavor descriptors. These were mixed (order balanced) with similar flavor offerings for ice cream and bottled water to mask the focus on e-cigarettes and validate the assessment. Mixed models contrasted interest between teens and adults and among adults by e-cigarette history.

Results:

Nonsmoking teens’ interest in e-cigarettes was very low (mean 0.41±0.14[SE] on 0-10 scale). Adult smokers’ interest (1.73±0.10), while modest, was significantly higher overall (p<0.0001) and for each flavor (most p-values<0.0001). Teen interest did not vary by flavor (p=0.75), but adult interest did (p<0.0001). Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor. Adults who never tried e-cigarettes had the lowest interest, yet still higher than nonsmoking teens’ interest (p<0.0001).


Conclusion

The e-cigarette flavors tested appealed more to adult smokers than to nonsmoking teens, but interest in flavors was low for both groups.

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Statistical bulletin: Adult Smoking Habits in Great Britain,

From the ONS website

Traduction en français plus bas dans la page

Use of e-cigarettes, and the relationship to smoking

The debate around use of e-cigarettes

E-cigarettes have been sold since 2004, and in Europe since 2006. Their popularity and availability has increased, which has led to debate around their use. Some feel that e-cigarettes could renormalise smoking, or could be a gateway to smoking by introducing non-smokers to nicotine. Others feel that they could be a useful tool in the effort to reduce tobacco consumption. To date, e-cigarettes have mainly been marketed as a cheaper and healthier alternative to smoking. However, the long-term health effects of using e-cigarettes have yet to be established. This has led to a World Health Organisation call for tighter controls on e-cigarettes.

ONS has chosen to publish preliminary findings on e-cigarette use in response to the emerging need for more information. These data were collected between January and March 2014. Complete 2014 findings are planned for publication as part of the next Adult Smoking Habits in GB publication in 2015.

Our preliminary findings

E-cigarettes were almost exclusively used by smokers and ex-smokers, Fig 11. More than 1 in 10 (12%) of cigarette smokers also used e-cigarettes, compared with 1 in 20 (5%) ex-smokers and almost none of those who had never smoked. These findings reflect those from a YouGov survey commissioned by Action on Smoking and Health (ASH). Data on e-cigarette use have also been collected as part of the Smoking Toolkit Study.

E-cigarettes were found to be used mainly as smoking cessation aids and for the perceived health benefits (compared with smoking tobacco). Over half of e-cigarette users said that their main reason for using e-cigarettes was to stop smoking, and about one in five said the main reason for their use was because they thought they were less harmful than cigarettes.

fig11_tcm77-386265

Fig. 11: E-cigarette use by cigarette smoking status, Great Britain, Q1 2014 (January to March)

Usage de la cigarette électronique, et lien avec le tabac

Le débat autour de l’utilisation des VPs

Les Vaporisateurs Personnels (VPs) sont en vente depuis 2004, et en Europe, depuis 2006. Leur popularité et leur disponibilité ayant augmenté, un débat à leur sujet s’est fait jour. Certains pensent que la vape pourrait « renormaliser » le tabac, ou pourrait servir de passerelle vers celui-ci, en accoutumant des non-fumeurs à la nicotine. D’autres pensent que ces dispositifs pourraient être un outil utile afin de diminuer la consommation de tabac.

A ce jour, les VPs ont été principalement promus comme une alternative au tabac, alternative plus saine et moins chère. Cependant, les effets à long terme de l’utilisation des VPs ne sont pas encore connus. Ce qui a poussé l’OMS à demander des contrôles renforcés sur ces dispositifs.

Le Bureau National anglais des Statistiques (ONS) a choisi de publier ces résultats préliminaires sur les VPs en réponse au besoin croissant d’informations à ce sujet. Ces données ont été collectées entre janvier et mars 2014. La publication des résultats complets est prévue dans le cadre des statistiques sur les habitudes des fumeurs adultes en Grande Bretagne, courant 2015.
Nos résultats préliminaires

Les VPs sont quasi-exclusivement utilisés par des fumeurs et des ex-fumeurs (voir fig. 11). Plus d’un utilisateur de tabac sur dix (12%) utilise aussi un VP, contre un sur vingt (5%) ex-fumeur, et virtuellement aucun non-fumeur. Ces résultats reflètent ceux d’une étude du site « YouGov »

Les VPs sont utilisées principalement comme outils de sevrage tabagique, ainsi que pour leurs bénéfices en termes de santé. Plus de la moitié des utilisateurs de VPs disent que la raison principale qui les a poussé à utiliser les VPs était le sevrage tabagique, et environ un sur cinq parce qu’ils pensent que les VPs sont moins nocifs pour la santé.

 

 

E-cigarettes and conventional cigarette use among US adolescents: A cross-sectional study

E-cigarette use is increasing rapidly among adolescents and e-cigarettes are currently unregulated.

The objective is to examine e-cigarette use and conventional cigarette smoking.

Published: July 2014

Positive: No

Link to article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142115/

Authors

Lauren M. Dutra, ScD
Stanton A. Glantz, PhD


Summary

Design

Cross-sectional analyses of survey data.

Setting

2011 and 2012 National Youth Tobacco Surveys (NYTS)

Participants

Representative sample of US middle and high school students in 2011 (n=17,353) and 2012 (n=22,529)

Exposures

Ever and current e-cigarette use

Main outcome measures

Experimentation with, ever, and current smoking; smoking abstinence

Results

In pooled analyses, among cigarette experimenters (≥1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (≥100 cigarettes; OR= 6.31, 95% CI [5.39-7.39) and current cigarette smoking (OR=5.96 [5.67-6.27]). Current e-cigarette use was positively associated with ever smoking cigarettes (OR=7.42 [5.63-9.79]) and current cigarette smoking (OR= 7.88 [6.01-10.32]. In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR=1.53 [1.03-2.28]). Among experimenters with conventional cigarettes, ever use of e-cigarettes was also associated with lower 30-day (OR=0.24 [0.21-0.28]), 6-month (OR=0.24 [0.21-0.28]), and 1-year (OR=0.25 [0.21-0.30]) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR=0.11 [0.08-0.15]), 6-month (OR=0.11 [0.08-0.15]), and 1-year (OR=0.12 [0.07-0.18]) abstinence. Among ever smokers of cigarettes (≥100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR=0.61, [0.42-0.89]), 6-month (OR=0.53, [0.33-0.83]) and one-year (OR=0.32 [0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR=0.35 [0.18-0.69]), 6-month (OR=0.30 [0.13-0.68]), and one-year (OR=0.34 [0.13-0.87]) abstinence.


Conclusion

E-cigarette use was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes.

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Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26 566 youth and adults from 27 Countries

This study assessed the prevalence and determinants of e-cigarette use among persons aged ≥15 years in 27 European Union (EU) member countries during 2012.

Published: 16 June 2014

Positive: Yes

Link to publication: http://tobaccocontrol.bmj.com/content/early/2014/04/30/tobaccocontrol-2013-051394.abstract?sid=e065daee-e796-4cd1-8bf5-30ae2696f39f

Authors

Constantine I Vardavas
Filippos T Filippidis
Israel T Agaku


Summary

Abstract

Objective This study assessed the prevalence and determinants of e-cigarette use among persons aged ≥15 years in 27 European Union (EU) member countries during 2012.

Methods The 2012 Eurobarometer 385 (77.1) survey was analysed for n=26 566 respondents. Knowledge, perception of harm, and determinants of e-cigarettes use were assessed, while separate regression analyses among current (n=7352) and former cigarette smokers (n=5782) were performed. National estimates of the number of e-cigarette users were also extrapolated.

Results 20.3% of current smokers, 4.7% of ex-smokers, and 1.2% of never cigarette smokers in the EU reported having ever used an e-cigarette (overall approximately 29.3 million adults). Among smokers, ever e-cigarette use was more likely among 15–24-year-olds (aOR 3.13, 95% CI 2.22 to 4.54) and 25–39-year-olds (aOR 2.00, 95% CI 1.47 to 2.78) in comparison to older smokers, and among those who smoked 6–10 cigarettes/day (aOR 1.53, 95% CI 1.10 to 2.13) or 11–20 cigarettes/day (aOR 2.07, 95% CI 1.52 to 2.81) in comparison to very light smokers (≤5 cigarettes/day). Moreover, e-cigarette use was more likely among smokers who had made a past year quit attempt (aOR 2.08, 95% CI 1.67 to 2.58). E-cigarette use among ex-smokers was associated only with the respondents’ age, with younger ex-smokers being more likely to have ever used an e-cigarette.


Conclusions

A substantial number of EU adults have ever used e-cigarettes. Ever users were more likely to be younger, current smokers, or past-year quit attempters. These findings underscore the need to evaluate the potential long term impact of e-cigarette use on consumer health, cessation and nicotine addiction and formulate a European framework for e-cigarette regulation within the revised EU Tobacco Product Directive.

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